RESUMO
Homograft implantation in the aortic position was a common approach for full root aortic surgical procedures in the early 2000s. Reintervention after degeneration of such homografts remains a challenge. We report two cases of successful implantation of the Edwards Intuity Elite rapid deployment valve into patients with degeneration of existing aortic homograft implants leading to severe aortic regurgitation.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana/métodos , Seguimentos , Rejeição de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação/métodos , Estudos de Amostragem , Índice de Gravidade de Doença , Fatores de Tempo , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Resultado do TratamentoRESUMO
This study features the longest experimental follow-up for decellularized heart valves implanted in an animal model. Porcine aortic heart valves were decellularized according to a disclosed standardized method in which TRITON X-100 and sodium cholate (TRICOL) are used in succession, followed by a further treatment with the endonuclease Benzonase to completely remove the nucleic acid remnants. Experimental animals (n = 17), represented by Vietnamese pigs (VPs), received a decellularized aortic allograft as a substitute for the replacement of their right ventricular outflow tract. The surgical implantation of the TRICOL-treated aortic valve conduit was successful in 11 VPs, while perioperative or postoperative complications occurred in the remaining six animals. In the sham-operated group (n = 4), the native pulmonary root was excised and immediately reimplanted orthotopically in the same animal. Echocardiography demonstrated a satisfactory hemodynamic performance of the TRICOL-treated valves during follow-up as well as the absence of relevant leaflet alterations concerning thickness and motility or valve insufficiency. At explantation, macroscopic inspection of tissue-engineered heart valve conduits did not evidence calcifications and showed a decreased wall thickness, comparable to that of the reimplanted native pulmonary roots. Noteworthy, extended functional performance, recovery of DNA content, and active extracellular matrix precursor incorporation are apparently compatible with the properties of a living self-supporting substitute.
Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valvas Cardíacas/fisiologia , Valvas Cardíacas/cirurgia , Engenharia Tecidual , Animais , Detergentes/química , Ecocardiografia , Feminino , Seguimentos , Glicosaminoglicanos/metabolismo , Valvas Cardíacas/ultraestrutura , Masculino , Octoxinol/química , Cuidados Pós-Operatórios , Colato de Sódio/química , Suínos , Engenharia Tecidual/métodosRESUMO
A 9-year-old boy was admitted to the emergency department for interscapular chest discomfort. Bidimensional echocardiography revealed a severe aortic root and sino-tubular junction dilatation with a suspicion of intimal flap at the aortic isthmus and a pseudo-aneurysm which was confirmed by a computerized tomography scan. The patient was immediately transferred to the operating room for an emergent replacement of the aortic isthmus. His recovery after surgery was uneventful, and he was discharged home 12 days later on beta blockers and angiotensin II receptor antagonist. A genetic recognition confirmed the diagnosis of Loeys-Dietz syndrome type I.
